경동맥 스텐트 삽입술로 완치된 안허혈증후군 1례
Ocular Ischemic Syndrome Successfully Treated With Carotid Angioplasty and Stenting
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목적: 안허혈증후군에서 뒤늦게 시행된 경동맥 스텐트삽입혈관성형술로도 성공적인 치료와 시력을 보이는 사례가 있어서 보고하는바이다. 증례요약: 52세 남자환자가 수개월 전부터 실내에서 실외로 나갔을 때 5분에서 10분 정도 잘 안 보이는 일과성 흑암시 증상이 우안에발생하여 내원하였다. 시력은 0.8, 홍채혈관신생은 관찰되지 않았고, 유두혈관신생과 망막동맥의 협소, 다수의 점상 망막출혈이 관찰되었다. 형광안저혈관조영 검사상 맥락막충만의 지연과 팔망막순환시간의 지연, 동정맥이행시간의 연장, 시신경유두 신생혈관과 여러군데의 망막허혈부위가 나타났으며 후기에서는 망막혈관주위로 누출이 다수 보였다. 자기공명영상혈관조영검사상 오른쪽 내경동맥근위부에서 심한 협착이 관찰되었다. 안허혈증후군으로 진단하고 스텐트삽입혈관성형술을 권유하였으나 시행하지 못하다가 진단 후약 6개월이 지나서 우측 경동맥의 협착부위에 스텐트삽입혈관성형술을 시행하였다. 수술 후 약 24개월에 시행한 검사상 일과성 흑암시는 사라지고, 나안시력은 1.0, 유두신생혈관은 섬유조직으로 변화되었으며, 형광안저혈관조영검사상 맥락막충만의 지연과 팔망막순환시간의 지연은 관찰되지 않았고, 시신경유두주위 누출과 망막허혈부위는 사라지고 주변부까지 혈액순환이 좋게 나타났다.
Abstract
Purpose: To report a case of ocular ischemic syndrome successfully treated with delayed carotid angioplasty and stenting (CAS). Case summary: A 52-year-old male was admitted to our hospital because of amaurosis fugax- like symptoms in the right eye for several months. His visual acuity was 0.8 in the right eye and he did not have rubeosis iridis. Neovascularization of the disc,narrowing of the retinal artery and multiple retinal hemorrhages were diagnosed by fundus examination. Fluorescein angiography showed delayed choroidal filling, a delayed arm-to-retina time, prolongation of arteriovenous transit time, neovascularization of the disc, retinal capillary nonperfusion, and staining of the retinal vessels. MR angiography showed severe stenosis in the proximal portion of the right carotid artery. We diagnosed this case as ocular ischemic syndrome. The patient was recommended carotid angioplasty and stenting at the severely narrowed portion of the right carotid artery, but it was postponed about six months after diagnosis because of personal problems. At the final follow-up, 24 months after stenting, the amaurosis fugax symptoms had disappeared, the patient had an improved visual acuity of 1.0, and the new vessels on the disc changed to fibrous tissue. Fluorescein angiography showed resolution of the delayed arm-to-retina time and prolongation of the arteriovenous transit time, disappearances of the leakage around the disc and the retinal capillary nonperfusion.
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